Drugs in Pregnancy Part 3: Colds, Coughs, Flu & Allergies

In Part 3 of our 7-part Drugs in Pregnancy series, we pick up a tissue in sympathy with the many women who suffer more-frequent colds and coughs over the 9 months of pregnancy. If you’re pregnant and suffering through your umpteenth respiratory event, you’re not alone. Pregnancy lowers your immune system’s effectiveness (a little trick your body plays so it won’t reject the foreign body that is your fetus!), so you may be more prone to suffering the slings and arrows of stuffy noses, coughs and colds.

Or, you might be worried about the safety of taking your regular allergy medicines. One thing you needn’t lose sleep over: That a cold or other illness will affect your child; it won’t. You may feel miserable, but your baby’s just fine. To find out more about how drugs are classified during pregnancy, look at our Drug Classification of Prescription Medicine During Pregnancy page.

Staying healthy for 9 months is a challenge, and the chances are good you’ll have at least one cold, and/or you may suffer seasonal allergies or get the flu. Prevention is certainly your best bet — a flu shot is wise, and officially recommended by the American College of Obstetricians and Gynecologists as soon as that season’s formulation is available. (The flu shot has been deemed safe for pregnant women according to the CDC), frequent hand-washing, a healthy diet and as much rest as you can manage are all smart ideas. That said, if you’re suffering through a bad cold or cough, it can be hard to rest, much less work or care for other children you have.

OTC Cold Medications

“Can I take this?” is a common question pregnant women ask their healthcare providers, unsure if the usual OTC cold med or cough suppressant is okay now. Says Lori Wolfe, certified genetic counselor and president of MotherToBaby, a free, national informational service of the non-profit Organization of Teratology Information Specialists, as long as you stick to antihistamine-based medications, and avoid using any cough and cold formulas containing decongestants, you are at little known risk for harming the fetus. Cough suppressants containing dextromethorphan (DM) and cough expectorants containing guaifenesin also have not been found to increase risk of fetal malformations.

What About the Flu?

Thanks again to those immune-system changes triggered by pregnancy, the flu can hit you pretty hard, which may cause problems to your unborn baby, including premature labor and delivery. Fever in early pregnancy can also lead to birth defects.

The CDC now recommends that pregnant women with influenza be treated with a flu drug because of concerns of developing a more severe illness. The antiviral drug Tamiflu works by attacking the flu virus to keep it from multiplying in your body, and reduce the symptoms or the severity of the symptoms. “If you have influenza, and your doctor recommends Tamiflu, the benefits to you would outweigh any adverse risks to the baby,” says Wolfe. As with all drugs, you should ask your doctor whether Tamiflu makes sense for you (you should be in the first 48 hours of having flu symptoms for the drug to be effective). Otherwise, Tylenol remains the recommended fever reducer during pregnancy. The CDC has flu recommendations for pregnant women that can be helpful.

Asthma and Allergy Drugs in Pregnancy

Asthma can be a life-threatening condition for the mother, so asthma medication should not be withheld during an asthma attack. Uncontrolled asthma has been associated with adverse maternal and perinatal outcomes. Again, talk to your doctor about which asthma medications have the least risk.

Some 20% to 30% of pregnant women experience allergies during pregnancy, either allergic rhinitis, such as seasonal allergies that cause sneezing, congestion, and itchy, watery eyes, or pruritis, such as hives or itchy skin. Neither of these conditions can kill you, so you may want to tough them out.

Antihistamines are one of the most common medications prescribed to pregnant women. “For antihistamines, we usually say that the benefits to you outweigh any known risk to the baby,” says Wolfe. “But we don’t recommend antihistamines near the time of delivery or while you’re breast feeding because they can slightly decrease your milk production.”

No antihistamine to date has been declared safe by the FDA to use during pregnancy. A review of antihistamine use during pregnancy found conflicting safety data. While a meta-analysis of more than 200,000 women found no increase in teratogenic risk with use of H-1 antihistamine blockers, certain animal studies of hydroxyzine, cyclizine, and promethazine have shown risks for birth defects.

Because of long-established use and positive animal and human data, chlorepheniramine (Chlor-Trimeton) and tripelennamine are the antihistamines of choice recommended for pregnant women. If you can’t tolerate or don’t respond well to these — both cause sedation —  ACOG recommends cetirizine (Zyrtec, Alleroff) and loratadine (Claritin), second-generation, non-sedating antihistamines, as the safest alternatives, but only after the first trimester because of their unknown teratogenic risk.

Decongestants, such as pseudoephedrine and phenylephrine, should be avoided entirely, says Wolfe, because they constrict blood vessels and may reduce blood flow to the developing fetus, and potentially cause birth defects.

Safe alternatives for nasal and sinus congestion include saline nasal sprays, a neti pot to flush out your nostrils, and a humidifier in your bedroom to keep nasal passages moist.

Further Reading about Drugs in Pregnancy

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